27 results on '"Sundeep Guliani"'
Search Results
2. Out‐of‐hospital extracorporeal membrane oxygenation cannulation for refractory ventricular fibrillation: A case report
- Author
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Jon Marinaro, Sundeep Guliani, Todd Dettmer, Kimberly Pruett, Doug Dixon, and Darren Braude
- Subjects
cardiac arrest ,extracorporeal membrane oxygenation ,out‐of‐hospital ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Out‐of‐hospital cardiac arrest survival continues to be dismal with the only recent improvement being that of extracorporeal cardiopulmonary resuscitation (E‐CPR) or cardiopulmonary resuscitation (CPR), augmented by extracorporeal membrane oxygenation (ECMO). Minimizing time until initiation of E‐CPR is critical to improve neurologically intact survival. Bringing E‐CPR to the patient rather than requiring transport to the emergency department may increase the number of patients eligible for E‐CPR and the chances for a good outcome. We developed a out‐of‐hospital E‐CPR (P‐ECMO) program that includes the novel use of a hand‐crank and emergency medical services (EMS) providers as first assistants. Here, we report the first P‐ECMO procedure in North America for refractory ventricular fibrillation involving a 65‐year‐old male patient who was cannulated in the field within the recommended 60‐minute low‐flow window and transported to our institution where he underwent coronary stenting. Details of program design and the procedure used may allow other systems to consider implementation of a P‐ECMO program.
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- 2020
- Full Text
- View/download PDF
3. Spontaneous inferior mesenteric arteriovenous fistula as a cause of severe portal hypertension and cardiomyopathy
- Author
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Jaideep Das Gupta, MD, Muhammad A. Rana, MD, Adam Delu, MD, Sundeep Guliani, MD, Mark Langsfeld, MD, and John Marek, MD
- Subjects
Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV) fistulas or malformations are extremely rare, with only 36 cases reported. Low incidence and nonspecific clinical signs and symptoms make mesenteric arteriovenous fistulas difficult to diagnose. We describe a case of a primary IMA-IMV fistula. Our patient presented with severe portal hypertension and cardiomyopathy along with robust arteriovenous connections between the IMA and IMV. Arterial embolization in this patient had to be followed by venous embolization for successful resolution of portal hypertension and cardiomyopathy. This case also highlights that close outpatient monitoring for treatment failure and recurrence is necessary for this disease process. Keywords: Inferior mesenteric artery, Inferior mesenteric vein, Arteriovenous fistula and malformation, Amplatzer, Embolization, Portal hypertension
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- 2019
- Full Text
- View/download PDF
4. The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
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Robin Osofsky, Ross Clark, Jaideep Das Gupta, Nathan Boyd, Garth Olson, LeAnn Chavez, Sundeep Guliani, Mark Langsfeld, John Marek, and Muhammad Ali Rana
- Subjects
Medicine (General) ,R5-920 - Abstract
Objective: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. Methods: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t -test and Fisher’s exact test. Results: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization ( n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p
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- 2021
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5. E-CPR in Cardiac Arrest due to Accidental Hypothermia Using Intensivist Cannulators: A Case Series of Nine Consecutive Patients
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Erik Kraai, Trenton C. Wray, Emily Ball, Isaac Tawil, Jessica Mitchell, Sundeep Guliani, Todd Dettmer, and Jonathan Marinaro
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Humans ,Hypothermia ,Critical Care and Intensive Care Medicine ,Cardiopulmonary Resuscitation ,Heart Arrest - Abstract
Background: Severe accidental hypothermia (AH) accounts for over 1300 deaths/year in the United States. Early extracorporeal life support (ECLS) is recommended for hypothermic cardiac arrest. We describe the use of a rapid-deployment extracorporeal cardiopulmonary resuscitation (E-CPR) team using intensivist physicians (IPs) as cannulators and report the outcomes of consecutive patients cannulated for ECLS to manage cardiac arrest due to AH. Methods: We reviewed all patients managed with veno-arterial (V-A) ECLS for hypothermic cardiac arrest between January 1, 2017 and November 1, 2021. For each patient- age, sex, cause of hypothermia, initial core temperature, initial rhythm, time from arrest to cannulation, cannula configuration, pH, lactate, potassium, cannulation complications, duration of ECLS, hospital length of stay, mortality, and cerebral performance category (CPC) at discharge were reviewed. Results: Nine consecutive patients were identified that underwent V-A ECLS for cardiac arrest due to AH. Seven (78%) were witnessed arrests. Initial rhythm was ventricular fibrillation (VF) in eight patients and pulseless electrical activity (PEA) in one. The mean initial core temperature was 23.8 degrees Celsius. The mean time from arrest to cannulation was 58 min (range 17 to 251 min). There were no complications related to cannulation. The mean duration of ECLS was 39.1 h. All nine patients were discharged alive with a Cerebral Performance score of one or two. Conclusion: In this case series of consecutive patients reporting intensivist-deployed E-CPR for cardiac arrest due to AH, all patients survived to discharge with a favorable neurologic outcome. A rapidly available E-CPR team utilizing intensivist cannulators may improve outcomes in patients with cardiac arrest due to AH.
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- 2022
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6. Long-term outcomes of open and endovascular axillosubclavian interventions after traumatic injury reveal high rates of limb dysfunction
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Hamza Hanif, Ross Clark, Sarah Moore, Nathan T. Morrell, John Marek, Muhammad Ali Rana, and Sundeep Guliani
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
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7. Vascular Surgery Role in Vascular Trauma: 11-Year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center
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Robin Osofsky, Hamza Hanif, Pierce Massie, Shannen Ramey, Richard Miskimins, Ross Clark, Muhammad Ali Rana, and Sundeep Guliani
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
- Full Text
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8. An Intensivist-Led Extracorporeal Membrane Oxygenation Program: Design, Implementation, and Outcomes of the First Five Years
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Erik Kraai, J. Pedro Teixeira, Ishan A. Patel, Trenton C. Wray, Jessica A. Mitchell, Naomi George, Ashley Kamm, Justin Henson, Aibek Mirrhakimov, Sundeep Guliani, Isaac Tawil, Todd Dettmer, and Jonathan Marinaro
- Subjects
Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Abstract
We describe the development, implementation, and outcomes of an intensivist-led adult extracorporeal life support (ECLS) program using intensivists both to perform venovenous (V-V), venoarterial (V-A), and extracorporeal cardiopulmonary resuscitation (ECPR) cannulations, and to manage patients on ECLS throughout their ICU course. All adults supported with ECLS at the University of New Mexico Hospital (UNMH) from February 1, 2017 to December 31, 2021 were retrospectively analyzed. A total of 203 ECLS cannulations were performed in 198 patients, including 116 V-A cannulations (including 65 during ECPR) and 87 V-V cannulations (including 38 in patients with COVID-19). UNMH intensivists performed 195 cannulations, with 9 cannulation complications. Cardiothoracic surgeons performed 8 cannulations. Overall survival to hospital discharge or transfer was 46.5%. Survival was 32.3% in the ECPR group and 56% in the non-ECPR V-A group. In the V-V cohort, survival was 66.7% in the COVID-19-negative patients and 34.2% in the COVID-19-positive patients. This large series of intensivist-performed ECLS cannulations-including V-A, V-V, and ECPR modalities-demonstrates the successful implementation of a comprehensive intensivist-led ECLS program. With outcomes comparable to those in the literature, our program serves as a model for the initiation and development of ECLS programs in settings with limited access to local subspecialty cardiothoracic surgical services.
- Published
- 2022
9. Out‐of‐hospital extracorporeal membrane oxygenation cannulation for refractory ventricular fibrillation: A case report
- Author
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Kimberly Pruett, Darren Braude, Doug Dixon, Sundeep Guliani, Todd S. Dettmer, and Jon Marinaro
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Out of hospital ,Emergency Medical Services ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,education ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Case Report ,Emergency department ,cardiac arrest ,lcsh:RC86-88.9 ,extracorporeal membrane oxygenation ,medicine.disease ,surgical procedures, operative ,Refractory ,Emergency medicine ,Ventricular fibrillation ,Extracorporeal membrane oxygenation ,Emergency medical services ,Medicine ,out‐of‐hospital ,Extracorporeal cardiopulmonary resuscitation ,Cardiopulmonary resuscitation ,cardiovascular diseases ,business - Abstract
Out‐of‐hospital cardiac arrest survival continues to be dismal with the only recent improvement being that of extracorporeal cardiopulmonary resuscitation (E‐CPR) or cardiopulmonary resuscitation (CPR), augmented by extracorporeal membrane oxygenation (ECMO). Minimizing time until initiation of E‐CPR is critical to improve neurologically intact survival. Bringing E‐CPR to the patient rather than requiring transport to the emergency department may increase the number of patients eligible for E‐CPR and the chances for a good outcome. We developed a out‐of‐hospital E‐CPR (P‐ECMO) program that includes the novel use of a hand‐crank and emergency medical services (EMS) providers as first assistants. Here, we report the first P‐ECMO procedure in North America for refractory ventricular fibrillation involving a 65‐year‐old male patient who was cannulated in the field within the recommended 60‐minute low‐flow window and transported to our institution where he underwent coronary stenting. Details of program design and the procedure used may allow other systems to consider implementation of a P‐ECMO program.
- Published
- 2020
10. Protocolized use of catheter-directed thrombolysis and echocardiography is highly effective in reversing acute right heart dysfunction in severe submassive pulmonary embolism patients
- Author
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Sundeep Guliani, Jaideep Das Gupta, Robin Osofsky, Jon Marinaro, John Marek, and Muhammad Ali Rana
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter directed thrombolysis ,030204 cardiovascular system & hematology ,Catheterization ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Thrombolytic Therapy ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Advanced and Specialized Nursing ,business.industry ,General Medicine ,Thrombolysis ,Middle Aged ,medicine.disease ,Pulmonary embolism ,Treatment Outcome ,Echocardiography ,Acute Disease ,Right heart ,Ventricular Function, Right ,Cardiology ,Female ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Safety Research - Abstract
Objective: The objective of this study was to evaluate the efficacy of protocolized use of catheter-directed thrombolysis and echocardiography in submassive pulmonary embolism patients. Methods: A retrospective study at a single institution of 28 patients that presented with submassive pulmonary embolism from July 2016 to September 2019 was performed. All patients were diagnosed using chest computed tomography demonstrating a pulmonary embolism and abnormal right ventricular to left ventricular ratio. Patients with severe right heart dysfunction (right ventricular to left ventricular ratio ⩾1.4) were protocolized to receive catheter-directed thrombolysis via EkoSonic catheters (EKOS Corporation, Bothell, WA, United States). Transthoracic echocardiogram was performed after 24 hours to assess right ventricular function and determine the need to continue thrombolysis. Patients after discharge then received follow-up echocardiograms at 6 weeks to determine new post-treatment baseline. Results: The mean patient age was 54.6 years, mean body mass index was 35.0, and mean right ventricular to left ventricular ratio on admission computed tomography imaging was 1.70. Interval mean right ventricular to left ventricular ratio on echocardiography during thrombolysis therapy was 1.01 (p Conclusion: This retrospective study demonstrates the effectiveness of protocolized use of catheter-directed thrombolysis and echocardiography in reversing severe right heart dysfunction in submassive pulmonary embolism patients.
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- 2020
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11. Hoarseness Caused by a Penetrating Proximal Descending Thoracic Aortic Ulcer and Pseudoaneurysm
- Author
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Jaideep Das Gupta, Nida Shahab Bham, Sundeep Guliani, John Marek, Garth T. Olson, Muhammad Ali Rana, and Robin Osofsky
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medicine.medical_specialty ,Palsy ,Ligamentum arteriosum ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,New onset ,Surgery ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,Landing zone ,medicine.artery ,medicine.ligament ,cardiovascular system ,Etiology ,Medicine ,Thoracic aorta ,cardiovascular diseases ,Differential diagnosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
We present a case of an 87-year-old female with new-onset hoarseness of unclear etiology. Imaging demonstrated a penetrating aortic ulcer (PAU) in the proximal descending thoracic aorta with an associated pseudoaneurysm that enlarged to a depth of 32 mm over 2 years. This patient was diagnosed with hoarseness being secondary to left recurrent laryngeal nerve (LRLN) palsy, a variant of Ortner syndrome. Patient was treated with endovascular stent-grafting successfully covering of the PAU and pseudoaneurysm with zone 3 proximal landing zone. The patient had moderate improvement in hoarseness after 1 year of follow-up. Endovascular repair is indicated for symptomatic patients with PAUs complicated by enlarging pseudoaneurysms or rupture. Endovascular treatment is effective with low procedural morbidity and mortality. In this case, the PAU and associated pseudoaneurysm at the level of the ligamentum arteriosum caused compression on the LRLN, resulting in a nerve palsy and hoarseness. This case highlights the importance of vascular imaging for patients presenting with unclear etiology of hoarseness or other signs of LRLN palsy. Therefore, aortic arch abnormalities, a variant of Ortner syndrome, even though rare, should be on the differential diagnosis of new onset hoarseness.
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- 2020
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12. Protocolized Whole-Body Computed Tomography Imaging After Extracorporeal Membrane Oxygenation (ECMO) Cannulation for Cardiac Arrest
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Robin Osofsky, Jaideep Das Gupta, Jonathan Marinaro, Sundeep Guliani, Ross M. Clark, Whitney Elks, Erik Kraai, Bryce Owen, and Muhammad Ali Rana
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medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,Computed tomography ,Catheterization ,Biomaterials ,Extracorporeal Membrane Oxygenation ,medicine ,Extracorporeal membrane oxygenation ,Hypoxic brain injury ,Humans ,In patient ,Extracorporeal cardiopulmonary resuscitation ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,General Medicine ,Cardiopulmonary Resuscitation ,Heart Arrest ,Anesthesia ,Concomitant ,Etiology ,Whole body ,business ,Tomography, X-Ray Computed - Abstract
Evaluate the utility of whole-body computed tomography (WBCT) imaging in detecting clinically significant findings in patients who have undergone extracorporeal membrane oxygenation (ECMO) cannulation for cardiac arrest (extracorporeal cardiopulmonary resuscitation or "eCPR"). Single-center retrospective review of 52 consecutive patients from 2017 to 2019 who underwent eCPR and received concomitant WBCT imaging. WBCT images were reviewed for clinically significant findings (compression-related injuries, cannulation-related complications, etiology of cardiac arrest, incidental findings, and evidence of hypoxic brain injury) as well as the frequency of interventions performed as a direct result of such findings. Thirty-eight patients met inclusion criteria for analysis. Clinically significant WBCT findings were present in 37/38 (97%) of patients with 3.3 ± 1.7 findings per patient. An intervention as a direct result of WBCT findings was performed in 54% (20/37) of patients with such findings. Evidence of hypoxic brain injury on WBCT was associated with clinical brain death as compared with those without such findings (10/15 [67%] vs 1/22 [4%], P < 0.001), respectively. WBCT scan after eCPR frequently detects clinically significant findings which commonly prompt an intervention directly affecting the patient's clinical course. We advocate for protocolized use of WBCT imaging in all eCPR patients.
- Published
- 2021
13. Same-Day ICU Discharge in Selected Patients With Severe Submassive Pulmonary Embolism Treated With Catheter-Directed Thrombolysis
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John Marek, Muhammad Ali Rana, Jaideep Das Gupta, and Sundeep Guliani
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,law ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Registries ,030212 general & internal medicine ,education ,Retrospective Studies ,education.field_of_study ,biology ,business.industry ,General Medicine ,Thrombolysis ,Emergency department ,Length of Stay ,Middle Aged ,medicine.disease ,Intensive care unit ,Troponin ,Patient Discharge ,Pulmonary embolism ,Intensive Care Units ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Cardiology ,biology.protein ,Female ,Surgery ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Vascular Access Devices - Abstract
A retrospective review from July 2016 to April 2018 was performed of 23 patients with submassive pulmonary embolism (PE) who received catheter-directed thrombolysis (CDT). Five (22%) of the 23 patients were discharged the same day from the intensive care unit (ICU) following thrombolysis completion. Their presentation, hospital courses, complications, and follow-up are reviewed. All 5 patients were diagnosed using chest computed tomography (CT) demonstrating a clot in the pulmonary vasculature and right ventricle dysfunction based on abnormal right ventricle to left ventricle (RV/LV) ratio. Patients with severe right heart dysfunction (RV/LV ratio ≥1.4) were protocolized to receive CDT via EkoSonic catheters (EKOS Corporation). Postoperatively, patients were admitted to the ICU with continuous alteplase at 1 mg/h. Echocardiography was then performed after 24 hours of therapy to assess right ventricle function and removal of EkoSonic catheters. Patients with reversal of right heart dysfunction and symptomatic improvement received bedside removal of catheters. The mean patient age was 50.6 years and body mass index was 33.6. Mean RV/LV ratio on admission via CT imaging was 1.56, with a mean troponin of 0.44. Interval mean RV/LV ratio on echocardiography after thrombolysis therapy was 0.91. There was a 0% incidence of periprocedural complications. One (20%) patient out of 5 had an emergency department visit 10 days postdischarge for acute shortness of breath, with workup revealing no evidence of recurrent PE. No patient required hospital readmission within 30 days. At the 6-week follow-up, all patients had continued normal right ventricular function noted on echocardiography. This case series demonstrates that for a select population of patients with severe submassive PE, the use of CDT and echocardiography monitoring can facilitate same-day discharge from the ICU.
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- 2019
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14. Spontaneous inferior mesenteric arteriovenous fistula as a cause of severe portal hypertension and cardiomyopathy
- Author
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Muhammad Ali Rana, Adam Delu, John Marek, Jaideep Das Gupta, Sundeep Guliani, and Mark Langsfeld
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medicine.medical_specialty ,Mesenteric arteriovenous fistula ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_treatment ,Fistula ,Cardiomyopathy ,lcsh:Surgery ,030204 cardiovascular system & hematology ,Inferior mesenteric artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Embolization ,0302 clinical medicine ,Internal medicine ,medicine.artery ,Case report ,medicine ,Portal hypertension ,Inferior mesenteric vein ,Arteriovenous fistula and malformation ,business.industry ,Arterial Embolization ,Amplatzer ,lcsh:RD1-811 ,medicine.disease ,lcsh:RC666-701 ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV) fistulas or malformations are extremely rare, with only 36 cases reported. Low incidence and nonspecific clinical signs and symptoms make mesenteric arteriovenous fistulas difficult to diagnose. We describe a case of a primary IMA-IMV fistula. Our patient presented with severe portal hypertension and cardiomyopathy along with robust arteriovenous connections between the IMA and IMV. Arterial embolization in this patient had to be followed by venous embolization for successful resolution of portal hypertension and cardiomyopathy. This case also highlights that close outpatient monitoring for treatment failure and recurrence is necessary for this disease process. Keywords: Inferior mesenteric artery, Inferior mesenteric vein, Arteriovenous fistula and malformation, Amplatzer, Embolization, Portal hypertension
- Published
- 2019
15. The effect of preoperative embolization on surgical outcomes for carotid body tumor resection
- Author
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Garth T. Olson, LeAnn Chavez, Robin Osofsky, Nathan H. Boyd, Ross M. Clark, Muhammad Ali Rana, Sundeep Guliani, John Marek, Mark Langsfeld, and Jaideep Das Gupta
- Subjects
medicine.medical_specialty ,lcsh:R5-920 ,business.industry ,cranial nerve injury ,Tumor resection ,General Medicine ,030204 cardiovascular system & hematology ,Shamblin classification ,Surgery ,03 medical and health sciences ,Preoperative embolization ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cranial Nerve Injury ,medicine ,preoperative embolization ,Carotid body ,Original Research Article ,business ,lcsh:Medicine (General) ,Carotid body tumor ,high-altitude - Abstract
Objective: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. Methods: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t-test and Fisher’s exact test. Results: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization ( n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p Conclusion: After controlling for tumor Shamblin classification and size, carotid body tumor resections following preoperative embolization were associated with increased operative time and inferior surgical outcomes compared to those tumors undergoing resection alone. Nonetheless, such results remain susceptible to the confounding effects of individual tumor characteristics often used in the decision to perform preoperative embolization, underscoring the need for prospective studies evaluating the utility of preoperative embolization for carotid body tumors.
- Published
- 2021
16. Vascular Surgery Role in Vascular Trauma: An 11-year Analysis of Peripheral Vascular Trauma Management at a Level 1 Trauma Center
- Author
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Sundeep Guliani, Robin Osofsky, Shannen Ramey, Andrew Fisher, Richard Miskimins, Ross Clark, and Mohammed Ali Rana
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
- Full Text
- View/download PDF
17. Ischemic Lumbosacral Plexopathy after Extensive Onyx Arterial Embolization for Type 2 Endoleak
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Adam Delu, Patrick McGrew, John Marek, Muhammad Ali Rana, Jaideep Das Gupta, and Sundeep Guliani
- Subjects
medicine.medical_specialty ,business.industry ,Arterial Embolization ,medicine.medical_treatment ,Treatment outcome ,medicine.disease ,Aortic aneurysm ,Text mining ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Embolization ,Cardiology and Cardiovascular Medicine ,business ,Lumbosacral plexopathy ,Abdominal surgery - Published
- 2019
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18. Resuscitative endovascular balloon occlusion of the aorta in trauma patients in youth
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Tatsuya Norii, Shin Miyata, Cameron Crandall, Yusuke Terasaka, Sundeep Guliani, and Stephen W. Lu
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Male ,medicine.medical_specialty ,Adolescent ,Resuscitation ,MEDLINE ,Shock, Hemorrhagic ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,In patient ,Child ,Aorta ,Retrospective Studies ,business.industry ,Age Factors ,030208 emergency & critical care medicine ,Retrospective cohort study ,Balloon Occlusion ,Surgery ,Balloon occlusion ,Child, Preschool ,Shock (circulatory) ,Hemorrhagic shock ,cardiovascular system ,Wounds and Injuries ,Female ,medicine.symptom ,business - Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has received increasing attention for critically uncontrolled hemorrhagic shock. However, the efficacy of REBOA in patients in youth is unknown.The aim of this study was to evaluate the mortality and characteristics of patients of age ≤18 years with severe traumatic injury who received REBOA.We retrospectively analyzed observational cohort data from the Japan Trauma Data Bank (JTDB) from 2004 to 2015. All patients ≤18 years old who underwent REBOA were included. Clinical characteristics and mortalities were analyzed and compared among patients ≤15 years old (young children) and 16-18 years old (adolescents).Of the 236,698 patients in the JTDB (2004-2015), 22,907 patients were 18 years old or younger. A total of 3,440 patients without survival data were excluded. Of the remaining 19,467, 54 (0.3%) patients underwent REBOA, among which 15 (27.8%) were young children. Both young children and adolescents who underwent REBOA were seriously injured (median Injury Severity Score [ISS], 41 and 38, respectively). Also, 53.3% of young children and 38.5% of adolescents survived to discharge after undergoing REBOA.In a cohort of young trauma patients from the JTDB who underwent REBOA to control hemorrhage, we found that both young children and adolescents who underwent REBOA were seriously injured and had an equivalent survival rate compared to the reported survival rate from studies in adults. REBOA treatment may be a reasonable option in severely injured young patients in the appropriate clinical settings. Further prospective studies are needed to confirm our findings.Epidemiologic study, level III; therapeutic study, level IV.
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- 2017
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19. Cannula-Associated Limb Ischemia Severity Score Predicts Need for Distal Perfusion Catheter Placement in Venoarterial Extracorporeal Membrane Oxygenation Patients
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Robin Osofsky, Sundeep Guliani, Ross M. Clark, Bryce Owen, Jaideep Das Gupta, Erik Kraai, Jonathan Marinaro, and Muhammad Ali Rana
- Subjects
business.industry ,medicine.medical_treatment ,Anesthesia ,Extracorporeal membrane oxygenation ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Catheter placement ,business ,Limb ischemia ,Perfusion ,Cannula - Published
- 2020
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20. Venoarterial extracorporeal membrane oxygenation is an effective management strategy for massive pulmonary embolism patients
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Jon Marinaro, Robin Osofsky, Todd S. Dettmer, Muhammad Ali Rana, Erik Kraai, Trenton Wray, Jaideep Das Gupta, Sundeep Guliani, Jessica A. Mitchell, and Isaac Tawil
- Subjects
Adult ,Male ,Time Factors ,medicine.medical_treatment ,Shock, Cardiogenic ,Hemodynamics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,medicine ,Extracorporeal membrane oxygenation ,Humans ,030212 general & internal medicine ,Cardiopulmonary resuscitation ,Registries ,Aged ,Retrospective Studies ,Creatinine ,business.industry ,Septic shock ,Mortality rate ,Anticoagulants ,Recovery of Function ,Length of Stay ,Middle Aged ,medicine.disease ,Pulmonary embolism ,Heart Arrest ,surgical procedures, operative ,Treatment Outcome ,chemistry ,Shock (circulatory) ,Anesthesia ,Surgery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
Treatment of massive pulmonary embolism (MPE) is controversial, with mortality rates ranging from 25% to 65%. Patients commonly present with profound shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used as a form of acute cardiopulmonary support in critically ill patients. We reviewed our institution's pulmonary embolism response team experience using VA-ECMO for patients presenting with advanced shock and/or cardiac arrest from MPE.From March 2017 to July 2019 we retrospectively reviewed 17 consecutive patients at our institution with MPE who were placed on VA-ECMO for initial hemodynamic stabilization.The mean patient age and body mass index was 55.8 years and 31.8, respectively. Ten of 17 patients (59%) required cardiopulmonary resuscitation before or during VA-ECMO cannulation. All patients had evidence of profound shock with a mean initial lactate of 8.95 mmol/L, a mean pH of 7.10, and a mean serum creatinine of 1.78 mg/dL. Seventeen of 17 cannulations (100%) were performed percutaneously, with 41% (n = 7) of patients placed on VA-ECMO while awake and using local analgesia. Five of 17 patients (29%) required reperfusion cannulas, with 0% incidence of limb loss. Overall survival was 13 of 17 patients (76%), with causes of death resulting from anoxic brain injury (n = 2), septic shock (n = 1), and cardiopulmonary resuscitation-induced hemorrhage from liver laceration (n = 1). In survivors, 12 of 13 patients (92%) were discharged without evidence of neurologic insult. The median duration of the VA-ECMO run for survivors was 86 hours (range, 45-218 hours). In survivors, the median length of time from ECMO cannulation to lactate clearance (2.0 mmol/L) was 10 hours and the median length of time from ECMO cannulation to freedom from vasopressors was 6 hours. Three of 13 patients (23%) required concomitant percutaneous thrombectomy and catheter-directed thrombolysis to address persistent right heart dysfunction, with the remaining survivors (77%) receiving VA-ECMO and anticoagulation alone as definitive therapy for their MPE. The median intensive care and hospital length of stay for survivors was 9 and 13 days, respectively.VA-ECMO was effective at salvaging highly unstable patients with MPE. Survivors had rapid reversal of multiple organ failure with ECMO as their primary therapy. The majority of survivors required ECMO and anticoagulation alone for definitive therapy of their MPE.
- Published
- 2019
21. 239: PULMONARY ARTERY SARCOMA MIMICKING PULMONARY EMBOLISM: A WORD OF CAUTION
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Sundeep Guliani, Jonathan Marinaro, Jessica Mitchell, and Aibek Mirrakhimov
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.artery ,Pulmonary artery ,medicine ,Cardiology ,Sarcoma ,Critical Care and Intensive Care Medicine ,medicine.disease ,business ,Pulmonary embolism - Published
- 2020
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22. Decompressive laparotomy for a patient on VA-ECMO for massive pulmonary embolism that suffered traumatic liver laceration after mechanical CPR
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Sundeep Guliani, Jaideep Das Gupta, Muhammad Ali Rana, Ramses Saavedra, and John Marinaro
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Decompressive laparotomy ,030208 emergency & critical care medicine ,Case Report ,030204 cardiovascular system & hematology ,Liver Laceration ,medicine.disease ,Surgery ,Pulmonary embolism ,03 medical and health sciences ,0302 clinical medicine ,Embolism ,Embolus ,Laparotomy ,medicine ,Extracorporeal membrane oxygenation ,Cardiopulmonary resuscitation ,cardiovascular diseases ,business - Abstract
Massive pulmonary embolism (PE) is an embolus sufficiently obstructing pulmonary blood flow to cause right ventricular (RV) failure and hemodynamic instability. We have utilized veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for early and aggressive intervention for massive PE patients. We present a case of a 61-year-old female placed on VA-ECMO for a massive PE while presenting in cardiac arrest and receiving mechanical cardiopulmonary resuscitation (CPR) via the LUCAS 2.0 device (Physio-Control Inc., Lund, Sweden). The patient suffered a severe liver laceration secondary to mechanical CPR and required a decompressive laparotomy. This case highlights that mechanical CPR during other interventions can lead to malposition of the device and could result in solid organ injury.
- Published
- 2018
23. 'ECMO FIRST' THERAPY IS EFFECTIVE AT REVERSING SHOCK AND SALVAGING HIGHLY UNSTABLE MASSIVE PULMONARY EMBOLISM PATIENTS
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Sundeep Guliani, Erik Kraai, Jon Marinaro, Todd S. Dettmer, Trenton Wray, Jessica Mitchell, Jaideep Das Gupta, Mohammed Rana, and Isaac Tawil
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Critical Care and Intensive Care Medicine ,medicine.disease ,Pulmonary embolism ,Internal medicine ,Shock (circulatory) ,medicine ,Cardiology ,Reversing ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
- Full Text
- View/download PDF
24. PROTOCOLIZED USE OF CATHETER-DIRECTED THROMBOLYSIS AND ECHOCARDIOGRAPHY IS HIGHLY EFFECTIVE IN REVERSING ACUTE RIGHT HEART DYSFUNCTION IN SEVERE SUBMASSIVE PULMONARY EMBOLISM PATIENTS
- Author
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Jon Marinaro, John Marek, Jaideep Das Gupta, Mohammed Rana, and Sundeep Guliani
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Catheter directed thrombolysis ,Critical Care and Intensive Care Medicine ,medicine.disease ,Pulmonary embolism ,Internal medicine ,Right heart ,medicine ,Cardiology ,Reversing ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
- Full Text
- View/download PDF
25. Angiographic embolization for hemorrhage following pelvic fracture: Is it 'time' for a paradigm shift?
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Mayur Narayan, Ronald Tesoriero, Thomas M. Scalea, Deborah M. Stein, Joseph J. DuBose, Sharon Boswell, Brandon R. Bruns, Sundeep Guliani, and Megan Brenner
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Adult ,Male ,medicine.medical_specialty ,Hemorrhage ,030230 surgery ,Critical Care and Intensive Care Medicine ,Time-to-Treatment ,03 medical and health sciences ,Fractures, Bone ,0302 clinical medicine ,Injury Severity Score ,Cause of Death ,Medicine ,Humans ,Blood Transfusion ,Registries ,Angiographic embolization ,Pelvic Bones ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Angiography ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,body regions ,Treatment Outcome ,Pelvic fracture ,Female ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Major pelvic disruption with hemorrhage has a high rate of lethality. Angiographic embolization remains the mainstay of treatment. Delays to angiography have been shown to worsen outcomes in part because time spent awaiting mobilization of resources needed to perform angiography allows ongoing hemorrhage. Alternative techniques like pelvic preperitoneal packing and aortic balloon occlusion now exist. We hypothesized that time to angiographic embolization at our Level 1 trauma center would be longer than 90 minutes.A retrospective review was performed of patients with pelvic fracture who underwent pelvic angiography at our trauma center over a 10-year period. The trauma registry was queried for age, sex, injury severity score, hemodynamic instability (HI) on presentation, and transfusion requirements within 24 hours. Charts were reviewed for time to angiography, embolization, and mortality.A total of 4712 patients were admitted with pelvic fractures during the study period, 344 (7.3%) underwent pelvic angiography. Median injury severity score was 29. Median 24-hour transfusion requirements were five units of red blood cells and six units of fresh frozen plasma. One hundred fifty-one patients (43.9%) presented with HI and 104 (30%) received massive transfusion (MT). Median time to angiography was 286 minutes (interquartile range, 210-378). Times were significantly shorter when stratified for HI (HI, 264 vs stable 309 minutes; p = 0.003), and MT (MT, 230 vs non-MT, 317 minutes; p0.001), but still took nearly 4 hours. Overall mortality was 18%. Hemorrhage (35.5%) and sepsis/multiple-organ failure (43.5%) accounted for most deaths.Pelvic fracture hemorrhage remains a management challenge. In this series, the median time to embolization was more than 5 hours. Nearly 80% of deaths could be attributed to early uncontrolled hemorrhage and linked to delays in hemostasis. Earlier intervention by Acute Care Surgeons with techniques like preperitoneal packing, aortic balloon occlusion, and use of hybrid operative suites may improve outcomes.Therapeutic study, level V.
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- 2016
26. Central aortic wire confirmation for emergent endovascular procedures: As fast as surgeon-performed ultrasound
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Brian J. Strife, Ajai K. Malhotra, Gordon Morano, Francisco C. Albuquerque, Daniel J. Komorowski, Michael Amendola, Sundeep Guliani, Mark M. Levy, M.K. Sydnor, and Jeffrey D. Elbich
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Male ,medicine.medical_specialty ,Point-of-Care Systems ,Hemorrhage ,Critical Care and Intensive Care Medicine ,Balloon ,medicine.artery ,Medicine ,Focused assessment with sonography for trauma ,Fluoroscopy ,Humans ,Aorta, Abdominal ,Ultrasonography ,Aorta ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Endovascular Procedures ,Angiography ,Ultrasound Identification ,Middle Aged ,Sagittal plane ,Femoral Artery ,medicine.anatomical_structure ,cardiovascular system ,Surgery ,Female ,Radiology ,Anatomic Landmarks ,business - Abstract
Background Uncontrolled hemorrhage is the leading cause of preventable death after trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an evolving technique for controlling noncompressible torso hemorrhage. A challenge limiting REBOA use is the dependence on fluoroscopy for confirmation of intra-aortic positioning of a guide wire, a necessary component for safe and accurate balloon deployment. The current study evaluates using surgeon-performed sonography alone, without fluoroscopy, in identifying the aorta and the presence of an intra-aortic guide wire. We postulate that with the use of the subxiphoid Focused Abdominal Sonography for Trauma (FAST) view, both the aorta and an intra-aortic guide wire can be reliably identified. Methods One hundred angiography patients underwent femoral arterial cannulation and guide wire advancement to the supraceliac aorta. From the subxiphoid FAST view, the aorta was identified in both sagittal and transverse planes. Intra-aortic wire identification was subsequently recorded. The rate of preferential central aortic wire positioning from unaided guide wire advancement was also observed. Results The mean patient age and body mass index were 61.8 years and 27.0 kg/m, respectively. Eighty-eight percent of the studies were performed using portable point-of-care ultrasound machines. Identification of the aorta via the subxiphoid FAST was successful in 97 (97%) of 100 patients in the sagittal and 98 (98%) of 100 patients in the transverse orientation. Among visualized aortas, an intra-aortic wire was identifiable in 94 (97%) of 97 patients in the sagittal and 91 (93%) of 98 patients in the transverse orientation. Unaided wire advancement achieved preferential central aortic positioning in 97 (97%) of 100 patients. Fluoroscopy-free ultrasound identification of an advancing intra-aortic guide wire was successful in 56 (98%) of 57 patients. Conclusion The subxiphoid FAST view can reliably identify a central aortic guide wire in both transverse and sagittal orientations. Unaided guide wire advancement has a high likelihood of both preferential central aortic positioning and subsequent ultrasound identification. These findings eliminate the need for routine fluoroscopy for this important initial maneuver during emergency endovascular procedures. Level of evidence Diagnostic study, level V.
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- 2015
27. Neurotrauma and Brain Death, Ventilatory Management
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Sundeep Guliani, Penny Andrews, and Nader Habashi
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- 2015
- Full Text
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